scholarly journals Community nurse-paramedics’ sphere of practice in primary care; an ethnographic study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tuija Rasku ◽  
Marja Kaunonen ◽  
Elizabeth Thyer ◽  
Eija Paavilainen ◽  
Katja Joronen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Content Analysis ◽  
Ethnographic Study ◽  
Care Providers ◽  
Community Nurse ◽  
Traditional Practice ◽  
Multidisciplinary Collaboration ◽  
Emergency Calls ◽  
Way Of Thinking

Abstract Background Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice. Methods A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis. Results Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models. Conclusions Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.

scholarly journals Community Nurse-Paramedics' Sphere of Practice in Primary Care; an ethnographic study

2020 ◽  
Author(s):  
Tuija Rasku ◽  
Marja Kaunonen ◽  
Elizbeth Thyer ◽  
Eija Paavilainen ◽  
Katja Joronen
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Participant Observation ◽  
Ethnographic Study ◽  
Care Providers ◽  
Community Nurse ◽  
Structured Interviews ◽  
Care Needs ◽  
Way Of Thinking ◽  
Practice Methods

Abstract Background Primary care, the principal function of the healthcare system, needs efforts from the local primary healthcare teams. Community Paramedicine has managed to reduce the use of Emergency Medical Services (EMS) for non-emergent calls. For the paramedic to move from traditional emergency call outs to non-emergency care means new demands. There is a paucity of paramedics’ experiences and perceptions of their novel roles as community paramedics. This study aimed to explore the community nurse-paramedics experiences of their new sphere of practice. Methods A descriptive ethnographic research was conducted collecting data through participant observation (total 317 hours) and semi-structured interviews (N = 24) in three Hospital Districts where the community nurse-paramedics (CNP) have worked at least one year. Both data were combined, organized, and analyzed with inductive content analysis. Results From the inductive content analysis, five themes emerged: the CNP's new way of thinking, the broad group of patients, the demanding way to provide care, the diversity of multi-agency collaboration and management challenges. The CNP needs an appropriate attitude for the care and the broader way of thinking than before, taking care of the patient but also about the family members. The CNPs pointed out as enablers for the way of providing care as challenges for the management of the CNP model. The diversity of multiagency collaboration team can be sensitive while offering new possibilities. Conclusion The CNP's deep involvement in patients' and families' care needs and the challenges of CNPs’ skills and competences. Their professional attitudes and eagerness to develop and maintain the multi-agency collaboration can offer preventive and long-term caring solutions from which the citizens and allied health, safety, and social care providers benefit locally and globally.

“There Are so Many Nuances . . . ”: Health Care Providers’ Perspectives of Pain Communication With Hmong Patients in Primary Care Settings

2020 ◽  
pp. 104365962095943
Author(s):  
Maichou Lor ◽  
David Rabago ◽  
Miroslav Backonja
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Content Analysis ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Limited English Proficiency ◽  
Qualitative Content Analysis ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pain Communication

Introduction While researchers have studied Hmong patients with limited English proficiency in pain communication, no research has examined primary care providers’ (PCPs’) interpretation of Hmong pain communication. This study examines PCPs’ pain communication experience with Hmong patients. Method A qualitative content analysis was conducted with PCPs. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. Results Fifteen PCPs—including seven physicians, one osteopathic physician, four nurse practitioners, and three physician assistants—participated. PCPs’ interpretations of pain communication with Hmong patients were characterized by three themes: (a) the providers experienced pain communication problems related to language, (b) the providers perceived the Hmong to have different beliefs about pain, and (c) the providers used different strategies to improve communication. Discussion The findings suggest that challenges are present in achieving effective pain communication between Hmong patients and their PCPs. Ineffective pain communication hinders the delivery of culturally congruent health care for Hmong patients.

scholarly journals The Odyssey from Symptom to Diagnosis of Pulmonary Hypertension from the Patients and Spouses Perspective

2021 ◽  
Vol 12 ◽  
pp. 215013272110292
Author(s):  
Bodil Ivarsson ◽  
Anders Johansson ◽  
Barbro Kjellström
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Pulmonary Hypertension ◽  
Content Analysis ◽  
Health Care Providers ◽  
Rare Diseases ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Care Hospital ◽  
Care Providers ◽  
Primary Care Hospital

Introduction/objective: Diagnostic delays in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are related to increased morbidity and mortality. The risk of a delayed, or even a missed, diagnosis is high as the conditions are rare. The aim was to describe patients’ and spouses’ experiences of the journey from the first symptom to an established diagnosis. Methods: A secondary analysis of 31 transcripts, based on 2 primary datasets containing interviews with 17 patients and 14 spouses, was carried out and analyzed according to qualitative content analysis. Results: One overarching category was revealed from the content analysis; “The journey from doubt and hope to receive the diagnosis.” Five subcategories were identified as: overall experiences; ignoring symptoms; seeking primary care/hospital specialty care; blame and stigma; and finding a pulmonary hypertension specialist clinic. The main finding was that both patients and spouses experienced that waiting for a diagnosis and the deteriorating state of health led to anxiety and frustration. The knowledge about rare diseases among health professionals needs to be improved to enable a timelier diagnosis and initiation of treatment. Conclusion: Patients’ and spouses’ lives were negatively affected by having to search for a correct diagnosis. In order for health care to identify rare diseases earlier, a well-functioning and responsive health care system, in primary care as well as in specialist care, is needed. Symptoms like breathlessness and fatigue are often unspecific but should not be ignored. Keeping the patient and spouse in the loop, and providing information that the search for an answer might take time is essential for health care providers to create trust.

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

scholarly journals Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals

2020 ◽  
Vol 6 (1) ◽  
pp. e1846844
Author(s):  
Anwen Zhang ◽  
Zlatko Nikoloski ◽  
Sarah Averi Albala ◽  
Winnie Yip ◽  
Jin Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Patient Choice ◽  
Care Providers ◽  
Care Facilities

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

A Scoping Review of Behavior Change Interventions to Decrease Health Care Disparities for Patients With Disabilities in a Primary Care Setting: Can Social Marketing Play a Role?

2021 ◽  
Vol 27 (1) ◽  
pp. 48-63
Author(s):  
Angela Makris ◽  
Mahmooda Khaliq ◽  
Elizabeth Perkins
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavior Change ◽  
Social Marketing ◽  
Health Care Disparities ◽  
Social Model ◽  
Care Providers ◽  
Social Model Of Disability ◽  
Behavior Change Interventions ◽  
The Social

Background: One in four Americans have a disability but remain an overlooked minority population at risk for health care disparities. Adults with disabilities can be high users of primary care but often face unmet needs and poor-quality care. Providers lack training, knowledge and have biased practices and behaviors toward people with disabilities (PWD); which ultimately undermines their quality of care. Focus of the Article: The aim is to identify behavior change interventions for decreasing health care disparities for people with disabilities in a healthcare setting, determine whether those interventions used key features of social marketing and identify gaps in research and practice. Research Question: To what extent has the social marketing framework been used to improve health care for PWD by influencing the behavior of health care providers in a primary health care setting? Program Design/Approach: Scoping Review. Importance to the Social Marketing Field: Social marketing has a long and robust history in health education and public health promotion, yet limited work has been done in the disabilities sector. The social marketing framework encompasses the appropriate features to aligned with the core principles of the social model of disability, which espouses that the barriers for PWD lie within society and not within the individual. Incorporating elements of the social model of disability into the social marketing framework could foster a better understanding of the separation of impairment and disability in the healthcare sector and open a new area of research for the field. Results: Four articles were found that target primary care providers. Overall, the studies aimed to increase knowledge, mostly for clinically practices and processes, not clinical behavior change. None were designed to capture if initial knowledge gains led to changes in behavior toward PWD. Recommendations: The lack of published research provides an opportunity to investigate both the applicability and efficacy of social marketing in reducing health care disparities for PWD in a primary care setting. Integrating the social model of disability into the social marketing framework may be an avenue to inform future interventions aimed to increase health equity and inclusiveness through behavior change interventions at a systems level.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

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